Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique.
Role of Perforating Artery Pedicled Neurotrophic Flap in the Treatment of Compound Tissue Defect of Tibia Using the Ilizarov Technique.
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带穿支动脉蒂神经营养皮瓣在应用伊利扎洛夫技术治疗胫骨复合组织缺损中的作用
DOI：
10.1111/os.13309
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发表时间：
2022-07
影响因子：
2.1
通讯作者：
Lou, Teng-fei
中科院分区：
文献类型：
--
作者：
Wu, Yuan-jian;Zhang, Yu-bo;Hamushan, Musha;Zhang, Wen-jun;Zhang, Tao;Li, Xu-jun;Han, Pei;Lou, Teng-fei
描述我们在伴有骨与软组织复合缺损的复杂下肢损伤治疗中联合应用带蒂神经营养皮瓣和牵张成骨的经验，并评估该方法的功能和美容效果。
在彻底清创和临时外固定后，应用带有明显穿支动脉的带蒂皮瓣进行软组织覆盖。在第二阶段，使用伊里扎洛夫外固定器替代临时外固定器，通过牵张成骨重建节段性骨缺损。2008年至2016年间，25例患者（16例男性，9例女性；平均年龄39.2岁）采用这种联合技术进行治疗。所有病例最初均被评定为古斯蒂洛 - 安德森ⅢB级开放性骨折。彻底清创后的软组织缺损范围从9cm×5cm到14cm×11cm，节段性缺损的平均大小为5.2（范围2.5 - 8.5）cm。其中17例患者有局部感染病史。由两名独立评估人员使用佩利标准评估骨结构和功能。
25例患者平均随访28.96（范围15 - 48）个月。13例患者应用远端蒂腓肠神经营养血管皮瓣，12例患者应用大隐神经营养皮支皮瓣。皮瓣面积从10cm×5cm到14cm×12cm。所有病例均实现了软组织缺损的充分覆盖。所有皮瓣完全成活，无并发症。骨缺损通过平均6.94（范围4.5 - 9.5）cm的延长得以矫正。所有病例的残余差异<1cm，无临床意义。12例患者功能评定为优，13例患者为良。18例患者的骨结果评定为优，7例患者为良。治疗过程中的并发症包括疼痛、针道感染、踝中足关节僵硬和对接部位不愈合。感染患者中未观察到感染复发。所有病例均成功保肢，功能恢复满意，无感染复发。
穿支动脉蒂神经营养皮瓣和牵张成骨的联合技术是治疗严重创伤和慢性感染下肢的一种有效的替代方法。
穿支动脉蒂神经营养皮瓣和牵张成骨的联合技术是治疗严重创伤和慢性感染下肢的一种有效方法。
To describe our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in the management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method. A pedicled flap with a marked perforator artery was applied for soft tissue coverage after radical debridement and temporary external fixation. In the second stage, the Ilizarov external fixator was used in place of the temporary external fixator for reconstruction of the segmental bone defect by distraction osteogenesis. Twenty‐five patients (16 men and nine women; mean age, 39.2 years) were treated by using this combined technique between 2008 and 2016. All cases were graded initially as Gustilo–Anderson grade IIIB open fractures. The soft tissue defect after radical debridement ranged from 9 cm × 5 cm to 14 cm × 11 cm, and the average size of segmental defect was 5.2 (Range, 2.5–8.5) cm. Seventeen of these patients had a history of local infection. The bone structure and function were evaluated by two independent evaluators using Paley's criteria. Twenty‐five patients were followed up for an average of 28.96 (Range, 15–48) months. The distally based sural neurovascular flap was applied in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. The flap area ranged from 10 cm × 5 cm to 14 cm × 12 cm. Sufficient coverage of soft tissue defect was achieved in all cases. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.94 (Range, 4.5–9.5) cm. The residual discrepancy was <1 cm in all cases, which was not clinically significant. The function was evaluated as excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in seven patients. Complications during treatment included pain, pin tract infections, ankle midfoot joint stiffness, and docking site nonunion. No recurrence of infection was observed in infected patients. All cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection. The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis is an effective alternative approach in the salvage treatment of massively traumatized and chronically infected lower extremities. The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis is an effective method in the salvage treatment of the massively traumatized and chronically infected lower extremity.
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影响因子：
3.6
作者：
Chim, Harvey;Sontich, John K.;Kaufman, Bram R.
通讯作者：
Kaufman, Bram R.
影响因子：
3.6
作者：
FRANCEL, TJ;VANDERKOLK, CA;YAREMCHUK, MJ
通讯作者：
YAREMCHUK, MJ
影响因子：
2.3
作者：
Lowenberg, David W.;Buntic, Rudolf F.;Parrett, Brian M.
通讯作者：
Parrett, Brian M.
影响因子：
3.6
作者：
Saddawi-Konefka D;Kim HM;Chung KC
通讯作者：
Chung KC
影响因子：
4.6
作者：
Lou, T-F;Hamushan, M.;Han, P.
通讯作者：
Han, P.